Diabetes Forum UK

About a week ago I joined a Facebook group supposedly for diabetics. After a bit of reading around I realised that the group had been set up and was administered by a homeopath. This set some alarm bells ringing. Then I noticed that he was offering "consultations" over Skype to the members of this group.

So my next thought was "is this an attempt to prey on vulnerable people and drum up business?"

Everyone has heard of homeopathy, but for anyone who doesn't know about it, heres the basics. They think that the more you dilute a substance, the more powerful it is and they use something which causes the original problem in order to "treat" it. So if you are having problems sleeping they may use a drop of coffee diluted in 100 drops of water. Then they tap it to "energise" it. Then they keep diluting it way past the point where there is absolutely none of the original substance left in it, tapping it every time.

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1)  Don't Panic.

We all panic at first.  Its a great shock to be diagnosed and all sorts of things run through your head.  There seems to be so much to learn and its all a bit much.  You dwell on the negatives and the future looks bleak.

However, its not as bad as it first appears.  With a little knowledge and advice from experienced diabetics you'll find that you are able to manage, understand and deal with diabetes.

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We know that carbs are the major problem for diabetics because thats what raises your blood glucose (BG), although the situation is slightly different for those who use insulin and those who do not.
For those who use insulin, the less carbs you eat, the more accurate you can be with your insulin dosage and be more controlled.
For people who do not use insulin the purpose of carb control is to stop the BG rising too far in the first place.
Because insulin users are balancing the number of units of insulin to inject against the number of carbs, the raw number of carbs is particularly relevant.  For T2s not on insulin this is very different.
T2s who are not on insulin are still producing insulin themselves, although the body is usually late in producing enough and releasing it into the bloodstream.  So the body will usually deal with the BG rise caused by the carbs eventually, but your BG will have gone far too high before your pancreas catches up and thats when the damage is caused.
So by managing carbs, we can control the BG rise.  But its not just about the raw number of carbs.  Different foods contain different types of carbs and these get converted to glucose at different speeds.  A baked potato will cause your blood glucose to rise extremely fast wheras some pulses and beans in particular will be far slower.  These slower carbs give the body longer to react, so it can keep up with the glucose better.
One way to get an idea of how fast and how far your blood glucose is likely to rise is the Glycemic Index (GI) and Glycemic Load (GL).  However these are only really a rough guess rather than hard facts.
So what seems to work best is the approach outlined in Jennifer's Advice - which is to test the effects of blood glucose on meals.  We tend to eat similar meals on a regular basis - for example I had weetabix or toast for breakfast for years before I was diagnosed.  So if you know the effects of meals on your blood glucose, you can find meals which do not raise your BG too far and continue to have those regularly.  If a meal raises your BG too high, then you can either avoid having that meal again or tweak the ingredients so that it has less of an effect.
This approach is commonly referred to as "managed carbs" as opposed to "low carb".  It doesn't necessarily mean a limit on the number of carbs - its just more based on managing what you eat in order to control your BG.
The low carb message on the other hand can be misinterpreted quite easily.  It started out as an approach for insulin users because it makes insulin dosing far more accurate.  With T2s not on insulin, the message can be too simplified and people tend to just concentrate on pure numbers of carbs.  Its quite possible to have more carbs of the right type and have lower BG rises.
So the number of carbs is not that important.  The effect that it has on your BG is.

Comment (2)

Its quite common for people to refer to the HbA1c as an average of their blood glucose but this isn't strictly true and can be quite misleading.

The first hint of this is that the HbA1c is reported as a percentage e.g. 6.0% wheras blood glucose readings are reported as mmol/l.

For example, if my Blood Glucose (BG) is 5.9mmol/l for an hour, then 6.1mmol/l for an hour, then my average over the 2 hours would be 6.0mmol/l.  It would not be 6.0%.  In the same way, if you have 2 apples weighing 49 grams and 51 grams, the average weight is 50 grams, not 50%.

Recently there was a change to reporting HbA1c in two ways - the old percentage figures and a new figure in mmol/mol.  So if your HbA1c were 6.0% then it would also be reported as 42mmol/l.

So does that mean my average blood glucose is 42mmol/l, when I usually see numbers betwen 4.0 and 8.0 on my meter most of the time?  No.

The reason for this difference is that they are measuring two different things and the HbA1c is not an average at all, but the two do follow very roughly in parallel.

What the HbA1c measures is the amount of red blood cells which have a glucose molecule attached to them.  In non-diabetics this is normally around 5% to 6% of all red blood cells.  thats perfectly normal.  In diabetics it can be higher because when your blood glucose is higher, more glucose attaches to red blood cells.

But the higher your blood glucose, the more chance there is of a glucose molecule attaching to a red blood cell.  So if you are running higher blood glucose, then your HbA1c will be higher.  Thats what I mean by them running roughly parallel.

The reason it may be misleading is that it appears from research that damage may be done to the body before any glucose attaches to red blood cells.  If your BG is 10.5 for a while then some small amount of damage may be done to the eye for example.  But although some damage has been done, your blood glucose was not at 10.5 for long enough to affect your HbA1c.

So your HbA1c might look fine, but its the peaks of your blood glucose that do the damage.

Small amounts of damage (microdamage) happens all the time and the body can repair some of it automatically.  If you keep your BG under control then this should not be too much of a problem.  However if you are having a lot of short high peaks, more microdamage is caused and may not be reflected in your HbA1c.

Looking again at averages, when we test blood glucose it tends to be before or after meals.  These are the times when the blood glucose changes the most, so your BG may be higher or lower at those times than the rest of the day.  The other approach is to use your fasting BG to work out roughly what your HbA1c should be.  The problem with that is that I can change my fasting BG by at least 1.0 mmol/l by having a snack before bed.  That throws the figures out considerably.  The only way to get a true average of your BG is to use a continuous glucose monitor which are very expensive and rare.

While there are calculators on various sites online, they are really just a rough guess about what you can expect your HbA1c to be.  They will nearly always be out to some degree, although often they will be out by the same range every time if you are consistent in the way you live your life.

But they also miss the point in that the real problem is the blood glucose peaks

This is a series of blog entries about diabetes myths.  Diabetes Myth #1 - Its all your own fault Diabetes Myths #2 - Its all about sugar
Diabetes Myth #3 - Calories Count Diabetes Myth #4 - Cures Diabetes Myth #5 - The Diabetic Diet Diabetes Myths #6 and #7 - "Diabetes is progressive" and "Pills or Insulin mean failure" Myth #8 - Glycemic Index is the answer. Now whats the question? Diabetes Myths #9 - Cholesterol Diabetes Myths #10 - HbA1c is an Average

Comment (5)

There's a few misunderstandings around the subject of cholesterol, in particular which numbers are important.

Cholesterol is made up of 3 main parts - LDL, HDL and Triglicerides (Trigs).  HDL is considered to be "good" and the other two "bad".

Early research into cholesterol and heart attacks came to this conclusion:
"high cholesterol means greater risk of heart attack"

Then they did some more research and narrowed it down to:
"high LDL cholesterol means greater risk of heart attack"

Then they did some more research and came up with:
"High levels of small particle LDL cholesterol means greater risk of heart attack".

Most people are not up to date with this and seem to be stuck on the first one, possibly the second.  So treatment for cholesterol tends to be based on what your total cholesterol test result is - despite the fact that we now know it revolves around LDL.  Even if a GP looks at the LDL test result, they will tend to prescribe a statin, which reduces the LDL - but this does not necessarily improve the particle size.

So the treatment does not necessarily address the right problem.

The real danger is the particle size of the LDL and because of the way that HDL, LDL and trigs are made, we can get an idea of the LDL particle size by looking at the relationship between trigs and HDL.  If you take your trigs result and divide it by your HDL result, a low number (below 1.3 at least) is good.  So high trigs are bad, high HDL is good.

So for example, if your total cholesterol is 5.2, this will be considered to be too high and you will probably be prescribed statins.  However, your detailed test results might reveal that your LDL is 1.9, Trigs 0.8 , and HDL is 3.5.  This is a pretty good profile and theres no reason to reduce your cholesterol at all.  Most of the cholesterol in this example is HDL - the good stuff.  The trigs are low which means that the LDL particle size is good.

But if you don't know what the cholesterol breakdown is, the total cholesterol of 5.2 can look quite bad.  On the other hand, your breakdown might be HDL 0.5, Trigs 1.5 and LDL 3.2 which is not good at all and you would need to take some action to sort out your cholesterol.

So from all that we know:
- HDL should be as high as possible
- trigs should be as low as possible
- LDL should not be ridiculous, but if the other two are ok then there may not be a problem.
- Total cholesterol doesn't actually tell you that much (unless its ridiculously high)

The most common treatment for high cholesterol is statin drugs.  Statins work to reduce the LDL specifically, but this appears to be a reduction in the overall level of LDL and may have no effect on particle size.  So they can quite easily be aiming at the wrong target.

A better approach to improving your cholesterol profile can be to lower your trigs and raise your HDL.

Trigs are manufactured in the body from carbohydrates.  Reducing the amount of carbohydrates in the diet tends to reduce the trigs.  HDL can be raised by increasing the amount of "good fats" in your diet - such as fish oils, nut oils and so on.  Often these two approaches lower the LDL at the same time.  Plus of course, lowering carbohydrates generally improves blood glucose(BG) levels as well.

The other factor which can make quite a difference in terms of cholesterol levels is exercise and in particular regular exercise.

There is however a lot of talk about reducing fat in order to reduce cholesterol and this is where there's more of a problem.  If you reduce your intake of the good fats, then your HDL will go down and your cholesterol profile will get worse.  Plus, most of the evidence for reducing fats helping cholesterol levels has been performed on people on a high carb diet.  It appears that if you eat less fats on a high carb diet, then your cholesterol goes down a little.  On the other hand, people on a lot less carbs, but eating MORE fat have a much better improvement in cholesterol levels and profile.

In a study involving 48000 canadian women on a low fat diet, over a period of 8 years, there was shown to be no signifcant improvement in the rates of heart disease.  However, all of the studies into low carb diets either show an improvement in overall cholesterol or an improvement in the cholesterol profile - or both.  However, this is only in studies where "low carb" is a significant reduction.  The standard intake of carbs is 230g per day.  Some "low carb" studies have been on 210g of carbs per day.  The studies which do show a significant difference are at levels of 150g/day or lower.

So eating less fat may make a small difference in reducing cholesterol, but eating less carbs appears to make far more of a difference.

There's another myth about cholesterol which is proving particularly hard to shift because "everyone knows" that eating eggs raise your cholesterol.  Except that it doesn't.  This is a misunderstanding based on the fact that eggs contain cholesterol.  But that cholesterol has to pass through your digestive system and get processed like all other foods and by the time it gets through all that, its been converted to something else.  Its no longer cholesterol.  So the cholesterol in eggs does not lead to higher cholesterol in your bloodstream *

This myth was debunked about 10 years ago but people still believe it today.  In an edition of BBC Radio 4's News Quiz last year, they mentioned a new survey that eating eggs does not raise cholesterol.  Nobody on the programme gave any indication that they were aware this was old news.  Its a myth that lives on, long after its been disproved.

Its not just eggs of course, but any food which contains cholesterol - something which is marked on many food packets in the USA, but not in europe.  Eating cholesterol is unlikely to raise your blood cholesterol level.

Finally, theres one other thing to consider.  Cholesterol is necessary.  It performs or helps with a number of functions in the body including the body's repair systems.  This may be why smokers have higher LDL levels in particular.  The body will increase its production of cholesterol in order to help repair the damage caused by smoking.  At diagnosis, many type 2 diabetics have high levels of triglicerides and this may be due to the damage caused by high BG, or perhaps a reaction to what is causing the insulin resistance.

This may in some way explain why elderly patients with very low levels of cholesterol (particularly women) have a higher mortality rate.  The cholesterol level is too low for some of the body's essential systems.

So when looking at cholesterol its important to look at the whole picture.  As with many things connected to diabetes, things are not as simple as they are first made out to be.  The more you dig into it and the more you increase your understanding the better off you will be.


*There are a tiny proportion of people for whom the opposite is true and eggs will raise their cholesterol according to research.  But this is the exception rather than the norm.

This is a series of blog entries about diabetes myths.  Diabetes Myth #1 - Its all your own fault Diabetes Myths #2 - Its all about sugar
Diabetes Myth #3 - Calories Count Diabetes Myth #4 - Cures Diabetes Myth #5 - The Diabetic Diet Diabetes Myths #6 and #7 - "Diabetes is progressive" and "Pills or Insulin mean failure" Myth #8 - Glycemic Index is the answer. Now whats the question? Diabetes Myths #9 - Cholesterol Diabetes Myths #10 - HbA1c is an Average

Comment (1)

This myth is not about the glycemic index as a whole, but about some of the hype surrounding it and the misunderstandings which arise.

The glycemic index (GI) certainly has its uses and its a good rough guide as to how fast foods will raise your blood glucose.  So its an indication of the speed that your BG will rise when you eat a particular food.  Its usually based on glucose having a GI of 100 and a food which raises your BG slower, will have a lower GI.  So wholemeal bread for example has a GI of around 70 (in the UK).

One of the most reputable sources for GI data is the University of Sydney GI testing service.  http://www.glycemicindex.com/

However, there have been some books, articles and so on which tend to overestimate the importance of GI particularly with reference to diabetes.  To understand why this is a problem, we must know certain things.

1)  GI testing is not performed on diabetics.  Its performed on 10 non-diabetics and the results are used to look at the average effect - a GI is calculated from these results.  They do not perform the tests on the same people every time, so theres no real comparison between the results.
2)  The GI does not tell you how long your BG will be raised for, or by how much.  Its just an indication of the speed of the rise.
3)  GI values are for individual foods.  As soon as you combine that food with another in the form of a meal, the GI changes.  Fats in particular can reduce the GI of foods.
4)  Particularly on food packaging, labels like "low GI" are meaningless.  They can mean whatever they want it to mean and the foods have not been tested in any standardised way
5)  The GI is very very specific.  There is no GI value for "an apple".  Gala, golden delicious, granny smith etc all have different GI values.
6)  Particularly with fruit & veg, factors such as the place where they were grown and their ripeness can make an enormous difference to the GI.
7)  Cooking methods change the GI.  Potatoes have a GI under 100, but baked potatoes have been clocked as high as 158.

So as you can see there are various problems with the GI - not that this renders it useless, but we need to bear in mind the above when looking at GI.  Despite all the problems, it still remains a useful rough guide.

I mentioned in point 2 that the GI does not indicate how high or for how long your BG will be raised.  The Glycemic Load does that.  These two are related and together give a far better indication of the probable effects on the BG.  For those who are more mathematically minded, the GL gives an indication of the area under the curve.

So a while ago GI became quite a buzzword and it seemed like everyone was talking about it.  Books on GI diets were everywhere and in the main, the messages given out were reasonable on the basis that if you eat lower GI foods in general then you will be better off.  But in some cases they did not take the GL into consideration, particularly if it was not aimed at diabetics - and to diabetics GL is the important one.

Look at it this way - the GI of wholemeal bread in the UK is between 68 and 72 depending on brand.  Since glucose with a GI of 100 is bad, wholemeal bread is often referred to as "low GI".  But the GI of table sugar is 65 - so its lower than bread.  Does that mean its better for diabetics to eat 100g of sugar rather than 100g of bread?

No.

So if we look at these things too simplistically, its easy to get the wrong idea.  This is particularly the case when foods are referred to as "low GI".  A DSF member was told on a course that a particular chocolate cake was "low GI" despite:
a)  She hadn't had it tested, so had no idea if this was true
b)  Where does "low" start and end?  Is it anything with a GI between 99 and 100?  Or between 5 and 10?
c)  Its clearly not low GI and the GL of any choc cake made with flour would be pretty bad.

Overall, despite the hype that makes the GI look like some magic bullet answer to diabetes, this is not the case.  What we really want to know is how foods will affect our BG and what we can eat without raising our BG too much and for too long.

The only way to reliably do this is to try things for yourself and see with your meter what the actual effect of a meal was on your BG and learn from it.  Perhaps try the meal again using a lower GI/GL version of one of the ingredients and see what that does to your BG.

So the GI and GL used together will not tell you what will work for you to keep your BG low.  But they do point you in the direction of things to try.

Further information on GI and GL:
http://www.mendosa.com/gi.htm

This is a series of blog entries about diabetes myths.  Diabetes Myth #1 - Its all your own fault Diabetes Myths #2 - Its all about sugar
Diabetes Myth #3 - Calories Count Diabetes Myth #4 - Cures Diabetes Myth #5 - The Diabetic Diet Diabetes Myths #6 and #7 - "Diabetes is progressive" and "Pills or Insulin mean failure" Myth #8 - Glycemic Index is the answer. Now whats the question? Diabetes Myths #9 - Cholesterol Diabetes Myths #10 - HbA1c is an Average

Comment (0)

These two myths are linked, so it makes sense to look at both at the same time.  We'll start with progression.

Myth #6 - Diabetes is Progressive

Its generally accepted that diabetes is a progressive condition, although this is being questioned more and more as diabetics learn from each other more on the web and gain better control.  Because of bad health advice and low expectations in the past there is an assumption that patients will be diagnosed, move quickly onto pills, then onto insulin with their health deteriorating along the way.

The problem is that historically, the expectations have been low and the targets unambitious.  The ideal of course is to have blood test results which are the same as those for non-diabetics and this is achievable for the majority of diabetics.  However if you get halfway towards that target then most GPs will be perfectly happy with that.  Also the dietary advice in particular from health professionals (see myth #5) makes it almost impossible to reach non-diabetic numbers as well.

Running high blood glucose over a long period does cause deterioration and so diabetes under those circumstances really is progressive.  The pills will stop working and you will move onto insulin.

But its doesn't have to be like that.  People who manage to get good control by learning what works to help control their blood glucose tend not to deteriorate or at least if there is progression, it is slowed down considerably.  The risks of diabetic complications such as blindness and kidney failure fall rapidly the closer you get to non-diabetic numbers.

So perhaps if our control is good enough we can avoid any progression at all.  Unfortunately things are never that simple and other things in life conspire to make things difficult, including other medical conditions interfering, but the better control we have overall, the less progression there will be.

So in a sense, diabetes is as progressive as you allow it to be, but its not all in your hands and luck is involved.  At the very least you can slow the progression right down.

Myth #7 - Pills or insulin mean failure

People want to avoid medication if possible and thats certainly understandable.  Its something we would all prefer to be without because even at its best its an extra little hassle you could do without.

But many people feel that if they have to start taking pills or have to start using insulin then its some kind of failure.

There's several reasons for this including the vague general preconception of the public that all diabetics have to do is stop taking sugar in their coffee.  But doctors can also often give the impression that they are "threatening" insulin or pills if you do not improve.  But one of the biggest factors which influences this sense of failure is the way that diabetes is seen as progressive.  Because there are some people out there who seem to be able to manage their diabetes with just diet and exercise, it seems to be assumed that everyone can and that they can do it forever.  So if you need medication to help control diabetes, you've not done as well as them and you have somehow failed.

This is quite definitely a misconception.  Diabetes affects different people to different degrees.  Genetically we are all different and our bodies react in different ways to all kinds of things.  So because we are all different, the degree to which diabetes is controllable is going to be different.  Plus our bodies age and if we are not expected to be as physically fit as 60 as we are at 18, we can assume that our bodies will be less able to cope with diabetes later in life than when we were younger.

In addition, the longer that diabetes is undiagnosed and untreated, the more of an effect it is likely to have.  Above I discussed how uncontrolled diabetes is progressive.  So if you were diabetic without knowing it for a period of years before being diagnosed, then the damage has been done and diabetes is going to have more of an effect on you.  This is in no way your fault, but its the situation you are faced with.

So just because one person can get away with treating their diabetes just with diet and exercise simply means they are lucky in that it was caught early enough to do something about it or their genetics mean they can get away with more.

But there's one more factor in this.  My prescription is 1500mg of metformin per day.  I estimate it would be possible for me to do without the metformin altogether and just control it with diet and exercise, but I won't.  Its techically possible for many type 2s to eat such a low carb diet that they do not need any medication at all, perhaps also doing an awful lot of exercise along the way.

But that is the point where it takes over your life completely.  Food is one long exercise in denial and exercise may have to be scheduled in after every meal in order to control blood glucose.  You could reach a point where your entire life is taken over by simply staying alive.  Is that really worth it?  Is someone in that position really better off just for the sake of avoiding taking a couple of pills every day?  Before the discovery and production of insulin, type 1 diabetics ate an almost no carb diet and usually died young.  If taking pills or insulin are a failure, they were a resounding success.

So medication can simply be a way of making life easier, even allowing you to have some kind of life which does not revolve around diabetes.  Even if you could techincally manage without the medication, it can take the pressure off enough to make things an awful lot easier.

If someone is blind then a white stick or a guide dog is not a symbol of some kind of failure.  They are just tools to get things done because they are either necessary or make life easier.

The biggest "threat" is that if you do not control diabetes well enough, you will need insulin.  If like me you are needle-phobic then its not a nice prospect at all.  But I would cope.  I know that if thats whats needed, then thats simply whats needed and I will get on with it.  From talking to insulin users for years I know its not as bad as people fear anyway.

When it comes to insulin there are even advantages which non-users do not have.  For starters, if someone is on a decent basal/bolus insulin regime then they can modify their dosage to balance for their carb intake.  So a type 1 can typically handle more carbs without going hyper than I can.  While its true that reducing carbs means less margin for error, a basal/bolus user can be a bit more "naughty" more often than me and has a tool which allows them to do it.

Even pills have their advantages as well.  Metformin for example is cardioprotective, so a type 2 diabetic taking metformin is less likely to have a heart attack than a type 2 diabetic who isn't.  ACE inhibitors such as ramipril are primarily for controlling blood pressure, but prevent kidney damage in the long term as well.

So rather than medication being a sign of failure, its simply a tool which might make things easier, have additional advantages and avoiding it could cause you further damage while you lose BG control.

So perhaps to some people since I take medication I am some form of "failure".  But I'd rather "fail" than be "successful" and dead.

This is a series of blog entries about diabetes myths.  Diabetes Myth #1 - Its all your own fault Diabetes Myths #2 - Its all about sugar
Diabetes Myth #3 - Calories Count Diabetes Myth #4 - Cures Diabetes Myth #5 - The Diabetic Diet Diabetes Myths #6 and #7 - "Diabetes is progressive" and "Pills or Insulin mean failure" Myth #8 - Glycemic Index is the answer. Now whats the question? Diabetes Myths #9 - Cholesterol Diabetes Myths #10 - HbA1c is an Average

Comment (0)

Of course one of the main concerns of a newly-diagnosed diabetic is food.  What can and can't I eat?  What should and shouldn't I eat?  As previously discussed, many people start off with "avoid sugar" but of course there is more to it than that.

Dietary advice in the UK stems from the British Dietetic Association - the professional body of dietitians, in conjunction with the Department of Health.  Since this is the official source, most other sources of advice (doctors, nurses, Diabetes UK etc) follow the guidance given out by these two bodies.  After all they are the experts.

When looking at diet, the content of food can be broadly summarised as: Carbohydrates, fat, protein, fibre, vitamins and minerals.

Now there is no denying that much of the advice is good to follow, making sure that we are taking in enough vitamins and minerals and so on.  The sources for these are generally unprocessed fruit & vegetables, so that tends to be a main focus.  This also tends to cover our needs for fibre.

The problem with the official advice lies with protein, fat and carbohydrates (carbs).  These are the 3 elements which have an effect on the blood glucose, to varying degrees.  Carbohydrates raise the blood glucose level and controlling the blood glucose level is the main concern for a diabetic.  Fats slow down the effects of carbohydrates on the blood glucose although how much of a difference they make is up for debate.  Protein does not have that much effect on blood glucose except under certain circumstances.

The official dietary advice for diabetics regarding these three is exactly the same as for non-diabetics - "base your meals on starchy carbohydrates"   This makes no allowance for the fact that carbohydrates raise your blood glucose.  Furthermore, the advice is to eat as little fat as possible and not overdo the protein.

If you are thinking "that will just push my blood glucose up too high" you're right.  So why do they recommend a diet which seems completely contrary to all common sense?

The simple answer is that they are terrified of fat.  This seemed to start in earnest in the early 50s with the publication of a report which claimed to prove that in countries where the population ate less fat, there was less heart disease.  Almost overnight most of the western dietary organisations and governments seem to have changed their policy based on the idea that fat is evil.

It sounds pretty convincing until you take a look at this report in more detail and discover that it appears the report's author threw away all the numbers he didnt want to see.  The report is the "Seven Countries" study and when you realise that he started out with data from 22 countries, you get an idea of how much got thrown away to come up with the "fat is evil" conclusion.

Studies since then have been very weak with the most convincing ones showing improvements in heart health from reducing fat a little bit while keeping everything else the same.  However, studies where the carbohydrates are reduced instead and even increase the fat intake considerably, show far better results.

We have all been conditioned over the years to think of fat as evil, but the more you look at it in detail (not just a report's conclusion), the less it seems to be true.  In the meantime this leads our official dietary advisors to tell us to load up on the very things that push our blood glucose up

So we need to look at things in a different way.  What can we eat without pushing our blood glucose up?  Well the simple answer to that is to try eating different things and see what happens to the blood glucose.  Then learn from that process to work out what foods and in what quantities we can eat without affecting the blood glucose too much.  Since we know that fat slows down the effects of carbohydrates on the blood glucose and ignore the "fat is evil" message, we can see the effects of increasing and decreasing fat on our blood glucose as well.  

Over time we build up a picture of what works for us.  Everyone is slightly different in the way that their body reacts to food and although we can get a rough idea of what works for everyone most of the time, things might be a little different for each one of us.

What happens when people give this a serious try is as follows:
1)  Their blood glucose is lower and easier to control.
2)  Their risk of complications fall considerably.
3)  Their cholesterol improves, reducing their risks of heart disease even if they are eating more of the "evil" fat
4)  They end up eating things they like rather than what some book says they should eat.
5)  They usually lose weight despite increasing their calories if they are overweight (see myth #3).
6)  They feel better generally day to day because their blood glucose is more stable and not being "spiked" by carbohydrate-heavy meals.

I should also mention protein.  It has been found that people with kidney problems should avoid protein.  Since people with diabetes are prone to get kidney problems, advice has sprung up that diabetics should avoid protein.  However, there is no danger from eating protein until the kidney problems actually start, so there is no reason for most people to avoid protein in order to protect their kidneys.  As it happens protein has been found to reduce hunger so it makes you feel fuller for longer and if you are trying not to overeat, thats a useful bonus.

So when we are diagnosed we are all looking for easy answers and the dietary advice is right there from all the official sources.  It may be a little more effort, but trying things out for yourself and learning from the process is far more effective.

So the final question has to be "if we know this works, why do they keep giving us the wrong advice?".  There are various theories on this and certainly the research has been done, but some biased research has been done as well.  Studies into "low carb" diets place the goalposts in very different places.  The standard official advice is to eat 230g of carbohydrate per day.  Some "low carb" studies test as much as 210g of carbohydrate per day.  Others go as low as 50g of carbohydrate per day.  So the results from these studies are bound to be very different and the conclusions they reach are also very different.

So if you have been conditioned to believe that fat is evil and look at research, you are far more likely to focus on the studies with 210g of carbohydrate per day, which will favour your position.  You will ignore the study on 48000 canadian women over 8 years on a low fat diet who had no improvement in heart disease risk and many others.  So the argument continues to rage on.

In the meantime, the only way to be sure is to try things out for yourself, learn from the results and find a diet which suits you.  Your dietitian/doctor/nurse may not like it, but its not their body they're playing with.

And someday they may actually try it for themselves, instead of just repeating what their book says.

This is a series of blog entries about diabetes myths.  Diabetes Myth #1 - Its all your own fault Diabetes Myths #2 - Its all about sugar
Diabetes Myth #3 - Calories Count Diabetes Myth #4 - Cures Diabetes Myth #5 - The Diabetic Diet Diabetes Myths #6 and #7 - "Diabetes is progressive" and "Pills or Insulin mean failure" Myth #8 - Glycemic Index is the answer. Now whats the question? Diabetes Myths #9 - Cholesterol Diabetes Myths #10 - HbA1c is an Average

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Not a week goes by without me seeing someone claim to have a cure for diabetes.  Its odd because considering there are 2 million diabetics in the UK, you would have thought it would have made the news.

Except of course that it hasn't made the news because its nonsense. There are a number of tricks which are used to make this sort of thing believable but we can see through those.

1)  Its in a book by someone selling the product.  If something is in a book, it tends to be more believable until you realise that someone can write anything in a book, whether its true or not.  Its not as if anyone checks before its published.  So although we tend to think that books are a source of knowledge, we have to remember that books can just as easily be full of lies, half-truths and misunderstandings

2)  They give a reference to a scientific study.  If there's a scientific study that says cinnamon cures diabetes, it must be true, right?  No.  For starters, there is one and its wrong.  The problem is that studies start off small, find some point of interest which is worthy of further study and what follows is bigger and more rigorous studies to see if there's anything in it.

Cinnamon is a good example.  An initial study seemed to be quite promising for its effects on diabetes, until some more detailed studies were done and found that it actually has no effect.  

There's various reasons for this including the placebo effect where if people genuinely believe they are getting some wonder drug, they will think they are better than they are.  Or things may actually improve since the human mind is a wonderful thing.  So in order to test properly you have to give half the people the product and give the other half something harmless but tell them its the same thing and see if there's a difference between the two.  Crucially the people doing the study shouldn't know which is which either, in case that skews the result.  This is roughly what's referred to as a double-blind study since neither the researchers nor the subjects know who got what until the results are collated.

It was when double-blind studies started being done on cinnamon (or cassia) that it emerged there was no effect.

But that doesn't stop people from seizing on the original small study, claiming all kinds of wonderful things and selling wonder products.  Whether or not they intend to deceive you (or are deceiving themselves) they refer to the first small indicator study as absolute proof that their product works.

Now some of these people may just be conning you, using the study as an excuse.  Others may just not know what they are doing and have thought that 2+2 = 22.  But whether they are dishonest or not, both types are wrong.

3)  "They don't want you to know".  The conspiracy theory con.  They may tell you that there is this cure, which all the scientists know about, but the medical community is suppressing it so that they can make money out of selling you drugs instead of curing you.  

All kinds of claims are made for conspiracies in relation to diabetes and if all of them were to be believed then there is a conspiracy between every doctor in the world, all the drugs companies, all the government health advisors, all the food companies, sweetener manufacturers, the masons, the CIA, the FBI, MI6, Prince Philip, Elvis and the aliens who kidnapped him.

The message is simple.  What they are trying to hint at is "they won't let me tell you about the wonderful things this product can do".  There's a reason for that.  There are laws preventing them from making unproven claims about products.  So they can't claim that this wonder pill cures cancer without actually proving first that it cures cancer.  So the reason they are being silenced is that they don't actually have any evidence that it works.  If there was any evidence they would use it and be able to make the claim.

So this is all a "the big boys are picking on me" con.

4)  Its a natural remedy thats been used for hundreds of years in some developing country such as Peru - China is a favourite.  This is often used in conjunction with the "big boys are picking on me" line.

It may have been used for centuries somewhere.  That doesn't mean it works.  For centuries leeches were used in Britain as a treatment for almost everything.  They didn't actually work on anything, despite lots of claims that they did.

Basically, we know better now.

Plus, the research done by pharmaceuticals companies has to start somewhere and its generally with a herbal remedy.  Take metformin as an example.  Its a chemical found inside a particular south american plant.  They analysed it and worked out which chemical actually had any effect from the couple of hundred chemicals in the plant.  Now they just produce the bit that actually does some good and don't give you the other 200 chemicals, in pill form.  This was over 30 years ago.

Now what are the chances that this guy tripped over a wonder drug which the pharmaceuticals companies (with their massive research budgets) missed?



At the end of the day, if this guy's theory or pill actually worked, he would not be selling 58 copies of a book online or spamming you with special offers for his wonder pill.  He would be off in Stockholm claiming his Nobel Prize.

Except for me of course, I have these chinese pills which will make you lose weight, cure diabetes, make you fantastically attractive and wealthy.  I tested them on myself and here's my study's conclusion... well I would tell you but the big boys are trying to silence me.  But if you send $5000 to my nigerian bank account in used, non-sequential notes I'll send you a copy of my book ;)

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I've written about this before, but I can't do a series on diabetes myths without mentioning calories since they may be the biggest con and/or misconception in nutrition.

We are regularly told by health authorities, food manufacturers and the media that we need to eat a calorie controlled diet.  But why?

A calorie is a measure of energy and your body uses energy not only for movement - jogging, swimming, poking the remote control, raising your pint glass etc - but for keeping your body's automatic systems going.  So your brain uses energy all the time, your heart uses energy to keep pumping and so on.  So yes we do need a certain amount of energy for the body to keep going.  If we take in more energy than we use up, it gets stored in the form of fat and we put on weight.

So far so good.  So whats the problem?

The problem is that calories in food are measured by putting a certain amount of food into a calorimeter, setting fire to it and then measuring how much energy is given off.  Does your body set fire to food?  Mine doesn't.

The body simply does not use energy in that way.  All the parts of your body are made up of a collection of cells, which use energy in the form of glucose.  Its similar to the way in which the cooker in your kitchen may use fuel in the form of electricity or gas or wood or coal.  The fuel that your body runs on is glucose.

And it doesn't set fire to it.

As discussed in myth #2, the body makes most of this glucose from carbohydrates - because its easier to make it from carbohydrates than it is to make it from fat or protein.  But when they set fire to food in a calorimeter, it doesnt take into account whether its burning carbohydrates, fat or protein.

Protein is used mainly by the body for building and repairing itself.  Since thats what the body mainly uses it for, its unlikely to get turned into glucose.  Some sources suggest that as little as 10% of the calories in protein get converted to glucose in a human on a "normal" diet.  The rest is used for repair and building.

So when you set fire to a steak, all the protein in it burns and gives off energy - but thats not what the body does with protein so the number of calories from burning a steak bears no resemblance to what the body really does with it.

Its a similar story with fat.  The body can make glucose out of fat, but its harder than making it out of carbohydrates.  They are on safer ground here though since if the body already has enough glucose from carbohydrates, it will convert the excess glucose to fat and store it as fat.  But there's still a difference.

If the body does not have all the glucose it needs from carbohydrates, it will convert fat to glucose.  But this is much harder to do, so it  "costs" energy to make glucose out of fat.  So some of those calories get lost.  Some sources suggest that as little as 30% of the calories get converted to glucose in a "normal" diet.

When looking at the classic "calorie controlled diet", people avoid fat because there's more calories worth of energy in fat when you set fire to it.  These are usually foods with more protein in them as well - meat, cheese etc.  But if most of the calories in protein and fat are never used for energy, then even though they have more calories in them to start with, they don't all "count".

But the calories in carbohydrates do count.

So a calorie controlled diet drives you towards a diet which has more carbohydrates in it, less fat and less protein.  But you're likely to wind up eating more effective calories than before.  This is bad enough for non-diabetics, but for diabetics its positively insane because more carbohydrates means higher blood glucose.  Because its harder for the body to make glucose out of protein and fat, it takes longer.  So your blood glucose rises slower and either your pancreas or your injected insulin (if you use it) has more of a chance to keep up.

So unless there is a furnace in your stomach and your body actually DOES set fire to food, then counting those calories is likely to lead you down entirely the wrong path and have you pushing your blood glucose much higher than it needs to be.

On the other hand if it does then you are about to become immensely rich because you will be the first species on the planet which uses energy in the same way that they measure it.

This is a series of blog entries about diabetes myths.  Diabetes Myth #1 - Its all your own fault Diabetes Myths #2 - Its all about sugar
Diabetes Myth #3 - Calories Count Diabetes Myth #4 - Cures Diabetes Myth #5 - The Diabetic Diet Diabetes Myths #6 and #7 - "Diabetes is progressive" and "Pills or Insulin mean failure" Myth #8 - Glycemic Index is the answer. Now whats the question? Diabetes Myths #9 - Cholesterol Diabetes Myths #10 - HbA1c is an Average

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